Pharmacologic treatment of delirium symptoms: A systematic review.

Objective: We conducted an updated, comprehensive, and contemporary systematic review to examine the efficacy of existing pharmacologic agents employed for management of delirium symptoms among hospitalized adults.
Methods: Searches of PubMed, Scopus, Embase, and Cochrane Library databases from inception to May 2021 were performed to identify studies investigating efficacy of pharmacologic agents for management of delirium.
Results: Of 11,424 articles obtained from searches, a total of 33 articles (N = 3030 participants) of randomized or non-randomized trials, in which pharmacologic treatment was compared to active comparator, placebo, or no treatment, met all criteria and were included in this review. Medications used for management of delirium symptoms included antipsychotic medications (N = 27), alpha-2 agonists (N = 5), benzodiazepines (N = 2), antidepressants (n = 1), acetylcholinesterase inhibitors (N = 2), melatonin (N = 2), opioids (N = 1), and antiemetics (N = 2). Despite somewhat mixed findings and a relative lack of high-quality trials, it appears that antipsychotic medications (e.g., haloperidol, olanzapine, risperidone, or quetiapine) and dexmedetomidine have the potential to improve delirium outcomes.
Conclusions: Pharmacologic agents can reduce delirium symptoms (e.g., agitation) in some hospitalized patients. Additional double-blinded, randomized, placebo-controlled clinical trials are critically needed to investigate the efficacy of pharmacologic agents for diverse hospitalized populations (e.g., post-surgical patients, patients at the end-of-life, or in intensive care units).
Competing Interests: Declaration of Competing Interest HA receives a stipend from the President and Fellows of Harvard College for editorial work as Deputy Editor of the Harvard Review of Psychiatry. CVA received honoraria from serving on the scientific advisory board of Biogen, Roche, Novo Nordisk, and Dr. Willmar Schwabe GmbH &Co. KG, funding for travel and speaker honoraria from Biogen, Roche diagnostics AG, Medical Tribune Verlagsgesellschaft GmbH and Dr. Willmar Schwabe GmbH &Co. KG and has received research support from Roche diagnostics AG. CC has received salary support from BioXcel Pharmaceuticals and honoraria for talks to Sunovion Pharmaceuticals on topics unrelated to this research. JH and CC have received stipends from Elsevier for editorial work for General Hospital Psychiatry. Others declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
(Copyright © 2022 Elsevier Inc. All rights reserved.)